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General NPI Number Information
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NPI Number | 1366630220
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Entity Type | Organization
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Legal Business Name | SHANAHAN PODIATRY PA
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 3909 GALEN CT SUITE 103
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-6824
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Country | US
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Telephone | 813-634-0664
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Fax | 813-634-0668
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Provider Business Mailing Address
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Address Line | 3909 GALEN CT SUITE 103
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-6824
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Country | US
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Telephone | 813-634-0664
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Fax | 813-634-0668
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Authorized Official
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Title or Position | AR TECHNOLOGIES
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Name | MRS. MARGARET JULIA HENRY
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Credential |
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Telephone | 813-685-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3134
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License Number State | FL
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